Outline

Objective: To review the results of 400 consecutive neuroendoscopic procedures at a single institution and refine the indications and success rates of particular procedures.

Methods: 400 patients were treated for a period of 7 years. 282 (70%) of the procedures were ETV, alone or in combination with other procedures. There were 64 arachnoid cysts, 10 cases of colloid cysts, and 60 cases with tumours were either biopsied or partially resected. End point for the assessment of the effectiveness of the procedures was the necessity for another procedure (shunt, fenestration, microsurgical excision of lesion where endoscopic resection was attempted, etc). All patients were assessed using CT and MR, including sequences for estimation of CSF flow and some cases with virtual endoscopy.

Results: Overall ETV effectiveness was 68%. A statistically significant predictor of success was the presence of AS (94% success rate, p=0.009) while tumour obstruction didn’t cause a difference on outcome (78% success rate, p=0.09). Age and early (before 1 y) or postinflammatory hydrocephalus were found to have negative impact on outcome (effectiveness below 35%, p<0.001 resp. 28%, p=0.018.). Arachnoid cyst fenestration was effective in 64.7% of the cases, and colloid cysts were resected without evidence of remnants in 80%. Histological verification was achieved in 90% of the tumour cases. Complication rate was kept below 9%, the majority of complications being minor and transient. No procedure related mortality was found. There was a clear evidence of a presence of a learning curve with noticeable decrease of the complications with the accumulated experience.

Conclusions: With proper selection of patients and types of interventions neuroendoscopy provides reliable and safe means of treatment for a variety of neurosurgical conditions.